Palmar Digital Nerve Research Articles

Anatomical Variation of the Recurrent Motor Branch of the Median Nerve.

The recurrent motor branch (RMB) of the median nerve has commonly thought to originate proximal to the terminal digital branches, although its anatomical course and number may vary. We report a rare variation of the RMB that arose from the second common palmar digital nerve. The median nerve bifurcated into the first and second common palmar digital nerves distal to the transverse carpal ligament, with the RMB dividing from the second common palmar digital nerve and traveling retrograde to enter the abductor pollicis brevis muscle. This high origin variation may be at increased risk of injury during procedures of the hand.

Lameness of horses is effectively ameliorated with a low volume of mepivacaine administered as a palmar digital nerve block.

To determine the effect of 1.5 mL 2% mepivacaine, 0.75 mL 2% mepivacaine, and a combination of 0.75 mL 2% mepivacaine with epinephrine (1:200,000 solution) administered over each palmar digital nerve (PDN) to 6 horses with naturally occurring lameness caused by digital pain. In a crossover study design, 6 horses with forefoot-related lameness were randomly assigned to 1 of 3 groups. Each group received, on different study days, a PDN block using 1.5 mL of 2% mepivacaine, 0.75 mL 2% mepivacaine, or 0.75 mL of a combination of 2% mepivacaine and epinephrine (1:200,000 solution) injected over each nerve. The horses' gait while trotting was analyzed with an inertial, sensor-based motion-analysis system immediately before treatment. The assigned treatment was then administered to the lame forelimb, after which the gait was reevaluated at 5-minute intervals for 15 minutes. All 3 treatments significantly reduced lameness scores at all gait evaluations, but the effect of treatment on the lameness score did not differ significantly among treatments. 0.75 mL of mepivacaine hydrochloric acid injected over each PDN was as effective as twice that volume in decreasing the lameness score of horses with digital pain. The 0.75-mL solution of mepivacaine/epinephrine injected over each nerve did not significantly improve the anesthetic effect of mepivacaine. For a palmar digital nerve block, a lower-than-commonly-recommended volume of 2% mepivacaine effectively ameliorates digital pain. This finding invites investigation as to whether administering a low volume of local anesthetic will more precisely localize pain.

Computed tomographic evaluation of the proximity of needles placed for perineural anesthesia of the palmar digital nerves to synovial structures in the foot: an ex vivo study.

Potential synovial penetration following palmar digital nerve blocks has not been investigated. To evaluate the proximity of needles placed for palmar digital nerve blocks to nearby synovial structures using computed tomography (CT). Descriptive observational study. In 18 cadaver forelimbs, sequential injection of the navicular bursa (NB), distal interphalangeal joint (DIPJ) and digital flexor tendon sheath (DFTS) was performed using 3, 5 and 10 mL diluted radiodense contrast medium, respectively. After each synovial injection, 25 gage needles were placed over the palmar digital nerves at the proximal aspect of the ungular cartilages (distal injections) and 1 cm further proximally (proximal injections), and CT examination was performed. Subsequently, needles were removed, and the synovial structures further distended with the same volume as for the first injection. Perineural needle placement and image acquisition were repeated. The distance between the needle tip and adjacent synovial structures was measured (mm) in reconstructed images. Results were analyzed in separate general linear mixed models, to determine the effect of needle position and synovial distension on the distance from the tip of the needle to the NB, DFTS and DIPJ. Synovial penetration was confirmed following 12/420 (3%) needle placements (NB n = 5, 1 after proximal and 4 after distal injections; DIPJ n = 2, DFTS n = 2, NB or DIPJ n = 3, all after distal injections). The mean distance from the needle tip to the NB and DIPJ was significantly smaller after the second distension (NB: p = 0.025; DIPJ: p < 0.001) and with the distal needle placements (NB: p < 0.001; DIPJ: p < 0.001). For the DFTS, the distance from the needle tip was significantly smaller with the proximal needle placements (p = 0.001). Ex-vivo study. There is a small risk of synovial penetration when performing palmar digital nerve blocks, especially when distension of adjacent synovial structures is present.

Anatomical and ultrasonographic landmarks of the manus nerves in camel (Camelus dromedarius)

This study aims to describe the anatomical and ultrasonographic features of manus nerves to establish a guideline approach for manus nerve block in camel practice. Twelve distal parts of the forelimbs cadavers of freshly slaughtered adult dromedary camels were used in this study. Six manus cadavers were used for anatomical morphology and the other six were used for ultrasonographic examination of the manus nerves. The gross anatomical study revealed the manus of the camel including, the third and fourth metacarpus and digits receives nerve supply from the ulnar, radial, and median nerves. These nerves continued along the camel manus as lateral and medial palmar metacarpal nerves and the axial and abaxial palmar proper digital nerves of the digits III and IV. Ultrasonographic evaluation of each nerve in the manus of the dromedary camel revealed proper localization and tracking of these nerves from the surrounding structures. In conclusion, the present study provides anatomical and ultrasonographic imaging knowledge tracking of the manus nerves in camels. This is important for determining the areas of the nerve block to attain successful regional anesthesia of this region in case of manus injuries in camel.

Is Active Synovitis of Metacarpophalangeal Joints a Neuropathic Condition in Rheumatoid Arthritis Patients? Results from an Ultrasound Study of Palmar Digital Nerves.

(1) Background: Rheumatoid arthritis (RA) is a chronic inflammatory joint disease, primarily characterized by pain. A significant proportion of patients report symptoms suggestive of neuropathic pain. The objectives of this study were to investigate the presence of an increased cross-sectional area (CSA) of the palmar digital nerves by ultrasound in patients with active synovitis of the metacarpophalangeal joints and to identify potential predictors of such an increase. (2) Methods: An ultrasound examination of the clinically most affected hand (from the second to the fifth metacarpophalangeal joint) was performed. The presence of synovitis was scored using a 0-3 semiquantitative method for each joint. The CSA of each pair of palmar digital nerves was measured. (3) Results: A significant correlation was found between the sum of the CSAs of the nerves and the Clinical Disease Activity Index (CDAI) (r = 0.387), as well as with the ultrasonographic grading of synovitis (r = 0.381) both at the patient and the joint level. These two variables, aimed at measuring disease activity, along with male gender, are the only predictors of the CSA of the palmar digital nerves. (4) Conclusions: Synovial inflammation of the metacarpophalangeal joints is, therefore, a condition that can influence the CSA of the palmar digital nerves and may partially explain neuropathic pain in patients with RA.

Development of an ultrasound-guided radiofrequency ablation technique in the equine cadaveric distal limb: histological findings and potential for treating chronic lameness.

Radiofrequency (RF) relieves chronic pain in humans, but it is unexplored in horses affected by chronic lameness. This study aims to describe the technique and the histological effects of ultrasound (US)-guided radiofrequency ablation (RFA) of palmar digital nerves (PDNs) in horse's fetlock and pastern, ex vivo. After assessing the US anatomy of lateral and medial PDNs in fetlock and pastern in vivo (n = 10 horses; 20 forelimbs), US-guided RFA was performed on these sites in cadaveric forelimbs (n = 10) applying four different settings with increasing invasiveness (n = 40 total treatments): 60°C, 6 min (GROUP LOW); 70°C, 4 min (GROUP MEDIUM); 90°C, 2 min (GROUP HIGH); 80°C, 8 min (GROUP VERY HIGH). Needle-tip-to-nerve proximity was assessed with US and methylene blue, injected through the port of the RF needle. Nerves were collected for microscopical assessment. Transverse palmaro-lateral and palmaro-medial US images of fetlock and pastern detected PDNs consistently, close to the palmar digital artery. With in-plane US technique, RFA was performed at target in 31/40 cases, with significantly higher number of failures in fetlock (p = 0.008). PDNs histology identified thermal injury/coagulation with axonal degeneration and collagen homogenation. Nuclear smearing of arterial leyomyocytes was also observed. Nerve coagulation was significantly associated with treatment (p = 0.03) and needle-tip-to-nerve proximity (US distance: p = 0.009; blue distance: p = 0.04). The PDNs were easily visualized and reached with the RF needle by US in-plane-guided technique. RFA produced axonal thermal damage and intensity-related coagulation effectiveness. To ensure effective nerve coagulation, it is crucial that the needle is accurately positioned in close proximity to the target nerve. Based on the histopathological findings, HIGH and VERY HIGH RFA treatments might be worth of being tested in vivo in clinical studies aimed at treating chronic lameness of the distal forelimb in horses.

Radiofrequency Ablation of Palmar Digital Branches of Ulnar Nerve in a Patient with Ulnar Neuropathy

Ulnar Tunnel Syndrome (UTS) is ulnar neuropathy at the wrist or hand typically caused by ganglion cysts, lipomas, wrist or hand compression, carpal bone fractures, carpal tunnel syndrome, or anything else that can impinge on the nerve. The symptoms of UTS can be uncomfortable and debilitating, with numbness and tingling of the 4th and 5th digits being the most common. Weakness of the ulnar portion of the hand can lead to decreased grip strength. UTS is typically managed with conservative treatment including anti-inflammatory oral medications, splinting, physical therapy, activity modification, acupuncture, and stretching. Second line treatment includes corticosteroid injections, although these have shown to have little efficacy. Surgery is also an option but may lead to iatrogenic ramifications. Radiofrequency ablation (RFA) is a treatment modality used for chronic pain, which utilizes heat to target nociceptive fibers. Traditionally, RFA is used in treating cervical and lumbar radiculopathy, but it is less studied in peripheral nerve areas. This case report examines a patient who had clinically significant pain relief after RFA to the palmar digital branches of the ulnar nerve. The patient was 63-year-old male who presented with left ulnar neuropathy that had been ongoing for 3 years. Despite conservative management, his symptoms of pain, paresthesia, and weakness persisted. The patient then elected to have a left cubital tunnel release at the elbow with anterior subcutaneous transposition. The surgery provided relief for three months but then led to worsening contractures and pain in the 4th and 5th digits of the left hand. Due to persistent symptoms after conservative management and surgical intervention, he was referred to interventional pain clinic. A decision was made to trial a digital nerve block of the left medial and lateral digital palmar nerves. Following the nerve block, the patient reported 100% improvement in pain and increased range of motion and function. Four weeks later, the patient returned for a radiofrequency ablation of the same nerves. In the week following the procedure, the patient reported that the pain in the little finger was entirely resolved. While radiofrequency ablation has become increasingly popular for the treatment of chronic back pain, its use in peripheral nerve pain has been limited to case reports and few randomized control trials. This case report highlights the successful use of radiofrequency ablation in the treatment of little finger pain and ulnar neuropathy by targeting the median and lateral branches of the palmar digital nerve.

The efficacy of injecting a distillate of the pitcher plant (Sarraceniaceae) adjacent to the palmar digital nerves of horses to ameliorate lameness caused by digital pain

This study aimed to determine the efficacy of instilling extract of the pitcher plant around the palmar digital nerves of horses to ameliorate digit pain causing lameness. Five mixed breed horses were recruited. Horses were determined to be lame because of pain in the distal portion of one or both thoracic limbs by a positive response to a basisesamoid nerve block using 2%^mepivacaine hydrochloride. Gait was evaluated pre- and post-nerve block at 30 min, 3, 7,14 and 21 days. At the 3-week evaluation, the basisesamoid nerve block was repeated using the extract, and the gait was evaluated at similar times. Lameness was evaluated objectively using a wireless, inertial, sensor-based, motion analysis system. The basisesamoid nerve block significantly ameliorated lameness at 30 min when gait was evaluated, but it had no significant effect on lameness after this time. The product containing extract of the pitcher plant had no significant effect on lameness when administered as a basisesamoid nerve block at any time. Extract of the pitcher plant administered adjacent to the medial and lateral palmar digital nerves (i.e., a basisesamoid nerve block) had no efficacy in ameliorating lameness in the distal portion of one or both thoracic limbs. Extract of the pitcher plant likely has no value for treating horses for chronic pain when administered as a regional nerve block.

Clinical study of palmar foot pain in 30 polo ponies with forelimb lameness in Thailand

Palmar foot pain is an important chronic problem that impairs the abilities of sport horses. Though there are several research on different types of horses, there is a lack of information regarding polo horses, which are known for using in unique sport. Therefore, this research aimed to find the prevalence of palmar foot pain in polo ponies with forelimb lameness in Thailand. The horses included in this study were 30 Argentine polo ponies: 10 geldings and 20 mares, aged from 7 to 20 years old. All were barefoot and had not exercised for at least 2 months. The ponies underwent lameness examination procedures with subjective and objective evaluation, including a trot on a straight line, left and right lunging, a full forelimb flexion test and a toe wedge test. Close inspections of hoof conformation, hoof percussion and hoof testing were done before performing a palmar digital nerve block. The result showed that 25 (83.33%) of 30 polo ponies had forelimb lameness, which can be divided into 56.7% with unilateral forelimb lameness, and 26.7% with bilateral forelimb lameness. There were 17 (56.7%) polo ponies that responded positively to the full flexion test and 25 (83.33%) that responded positively to the hoof tester and percussion at the frog area. However, only 9 ponies (30%) were positive to palmar nerve block. In conclusion, this study reveals a notable incidence of forelimb lameness and palmar foot pain. Understanding palmar foot pain prevalence is vital for further equine health management.

Electrophysiological and Ultrasonographic Evaluation of Palmar Digital Nerve Injury in Distal Finger

Electrophysiological evaluation of distal lesions in the palmar digital branch of the median nerve presents a significant challenge. We present a case of lateral palmar digital neuropathy of the median nerve, which was confirmed through clinical, electrophysiological, and ultrasonographic assessments. A 54-year-old woman was referred to our electrophysiology laboratory for persistent numbness and a tingling sensation on the radial side of the distal phalanx of her left second finger. She had a laceration injury on the middle phalanx of the second finger and underwent neurorrhaphy of the lateral branch of the palmar digital nerve 8 months ago. Sensory nerve conduction studies, both antidromic and orthodromic, showed low amplitude responses for the lateral branch of the palmar digital nerve. Ultrasonography revealed swelling of this nerve branch within the middle phalanx of the second finger. When patients report sensory symptoms in a specific area, it is important to evaluate for potential cutaneous nerve injuries using electrophysiological studies. Additionally, high-resolution ultrasonography is a valuable tool for investigating small cutaneous nerve lesions, even in the distal finger.

A novel nerve block technique for nail surgery.

In pediatric patients, nail unit anesthesia is frequently required for procedures including matrixectomy or nail avulsion. However, nail unit anesthesia is very painful and requires a significant amount of time to take complete effect, causing a great deal of distress for most pediatric patients. By targeting the palmar and dorsal digital nerves in the distal part of the fingers, our method enables fast, simple, and less painful anesthesia.

Pharmacokinetics and metabolism of lidocaine HCl 2% with epinephrine in horses following a palmar digital nerve block

BackgroundLidocaine is a local anesthetic that is sometimes administered in combination with epinephrine. The addition of epinephrine increases the time lidocaine remains at the site of administration, thus prolonging the duration of effect. Due to their potential to prevent the visual detection of lameness, the administration of local anesthetics is strictly regulated in performance and racehorses. Recent reports of positive regulatory findings for lidocaine in racehorses suggests a better understanding of the behavior of this drug is warranted. The objective of the current study was to describe serum and urine concentrations and the pharmacokinetics of lidocaine and its primary metabolites following administration in combination with epinephrine, as a palmar digital nerve block in horses. Twelve horses received a single administration of 1 mL of 2% lidocaine HCl (20 mg/horse) with epinephrine 1:100,000, over the palmar digital nerve. Blood samples were collected up to 30 h and urine samples up to 48 h post administration. Lidocaine and metabolite concentrations were determined by liquid chromatography- mass spectrometry and pharmacokinetic (non-compartmental and compartmental) analysis was performed.ResultsSerum concentrations of lidocaine and 3-hydroxylidocaine were above the LOQ of the assay at 30 h post administration and monoethylglycinexylidide (MEGX) and glycinexylidide (GX) were below detectable levels by 24 and 48 h, respectively. In urine, lidocaine, MEGX and GX were all non-detectable by 48 h post administration while 3-hydroxylidocaine was above LOQ at 48 h post administration. The time of maximal concentration for lidocaine was 0.26 h (median) and the terminal half-life was 3.78 h (mean). The rate of absorption (Ka) was 1.92 1/h and the rate of elimination (Kel) was 2.21 1/h.ConclusionsCompared to previous reports, the terminal half-life and subsequent detection time observed following administration of lidocaine in combination with epinephrine is prolonged. This is likely due to a decrease in systemic uptake of lidocaine because of epinephrine induced vasoconstriction. Results of the current study suggest it is prudent to use an extended withdrawal time when administering local anesthetics in combination with epinephrine to performance horses.

Plexiform Schwannoma of Digital Nerve.

Plexiform schwannoma is an uncommon benign tumour that grows in a plexiform pattern. We report a 47-year-old man with a mass on the palmar aspect of the metacarpophalangeal joint of the right index finger that had been growing gradually for more than 10 years. The mass was palpated from the distal carpal tunnel to the ulnar aspect of the proximal interphalangeal joint of the index finger, with tingling and numbness sensation. The tumour was a multinodular tumour involving the first common palmar digital nerve to the ulnar proper palmar digital nerve. It was resected and reconstructed with a sural nerve graft. Plexiform schwannoma is rare in the digital nerve, with only six cases reported. Generally, classic schwannomas can be enucleated without causing neurologic deficits; however, plexiform schwannoma may require nerve resection. There have been reports of recurrence of plexiform schwannoma; definitive resection and long-term follow-up are necessary. Level of Evidence: Level V (Therapeutic).

Highlights of recent clinically relevant papers

Equine Veterinary EducationVolume 35, Issue 6 p. 282-283 RESEARCH HIGHLIGHTS Highlights of recent clinically relevant papers Sue Wright, Corresponding Author Sue Wright [email protected] orcid.org/0000-0002-5513-8571 EVE Editorial Office Email: [email protected]Search for more papers by this author Sue Wright, Corresponding Author Sue Wright [email protected] orcid.org/0000-0002-5513-8571 EVE Editorial Office Email: [email protected]Search for more papers by this author First published: 03 May 2023 https://doi.org/10.1111/eve.13797Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References Fouquet, G., Abbas, G., Johnson, J.P., Pompermayer, E., Harel, C., Aldous, E. et al. (2022) Ultrasound-guided injection technique of the equine cervical nerve roots. Frontiers of Veterinary Science. Available from: https://doi.org/10.3389/fvets.2022.992208 eCollection 2022. Kolding, S.A., Sørensen, J.N., Kramer, J., McCracken, M.J., Reed, S.K. & Keegan, K.G. (2023) Prevalence and clinical significance of increasing head height asymmetry as a measure of forelimb lameness in horses when trotting in a straight line after palmar digital nerve block. Equine Veterinary Journal. Available from: https://doi.org/10.1111/evj.13921 Melly, V., Ortved, K.F., Manzi, T.J., Richardson, D.W., Stefanovski, D. & Wulster, K.B. (2023) Identification of a previously unreported site of subchondral bone injury in the dorsodistolateral calcaneus in thoroughbred racehorses. Equine Veterinary Journal. Available from: https://doi.org/10.1111/evj.13928 Miglinci, L., Reicher, P., Nell, B., Koch, M., Jindra, C. & Brandt, S. (2023) Detection of equine papillomaviruses and gamma-herpesviruses in equine squamous cell carcinoma. Pathogens, 12(2), 179. Available from: https://doi.org/10.3390/pathogens12020179 Wanstrath, M.A., Bauck, A.G., Smith, A.D. & Freeman, D.E. (2022) Surgical enlargement of the epiploic foramen in horses. Veterinary Radiology & Ultrasound, 52, 308– 314. Available from: https://doi.org/10.1111/vsu.13927 Wolkowski, D.D., McCarthy, R.D., Schoonover, M.J., Taylor, J.D. & Eastman, T.G. (2022) Effects of intra-articular injection of an acellular equine liquid amniotic allograft in healthy equine joints. Veterinary Surgery, 52, 62– 68. Available from: https://doi.org/10.1111/vsu.13918 Volume35, Issue6June 2023Pages 282-283 ReferencesRelatedInformation

Anatomical observation and CT three-dimensional reconstruction of Five-shu acupoints of Shaoyin Heart Meridian in rabbit's forelimb

To investigate the location and anatomical structure of "Shaochong"(HT9), "Shaofu"(HT8), "Shenmen"(HT7), "Lingdao"(HT4) and "Shaohai"(HT3) in the rabbit's forelimb. Sixteen rabbits (half male and half female) were used in the present study. By referring to the national standards on the location of acupoints in the human body and the literature about the location of acupoints in the rabbit, and by using the method of comparative anatomy, the location and needling operation of the Five-shu acupoints of Shaoyin Heart Meridian on the rabbit's forelimb were defined, and these acupoints were needled and CT three-dimensional reconstruction were conducted. Then, the rabbits were killed, and intravascular perfusion was performed, followed by inserting acupuncture needles into these five acupoints for observing the anatomical relationship between the inserted acupuncture needle and the structure of surrounding tissues. HT9 is located at the medial side of the little finger of forelimb, about 1 mm beside the nail root, and is adjacent to the superficial flexor tendon of the finger, the dorsal branches of the proper palmar digital artery and vein, and the endings of dorsal branch of palmar digital proper nerve of the ulnar nerve on the fifth finger side. HT8 is located at the palm side of the forelimb, horizontally parallel to the proximal end of the 5th metacarpophalangeal joint and between the 4th and 5th metacarpal bones, and is adjacent to the lumbricalis, the 4th and 5th interossei, and common palmar digital artery and vein and the palmar digital proper nerve of the ulnar nerve. HT7 is located at the medial margin of the extensor carpal tendon on the ulnar side, between the distal end of the ulna and the ulnar carpal bone, and is adjacent to the tendons of flexor carpi ulnaris and extensor carpi ulnaris, ulnar artery, ulnar vein and ulnar nerve. HT4 is located at the medial border of the ulnar flexor tendon, about 1.5 cun superior to HT7, and is adjacent to extensor carpi ulnaris, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, ulnar artery, vein and ulnar nerve. HT3 is located at the depression, medial to the condyle of humerus when the elbow is bent at 90°, its neighbor structure is composed of pronator teres, biceps brachii, brachial artery and vein, radial collateral artery, radial collateral vein, medial antebrachial cutaneous nerve and median nerve. In the rabbit, there is a close relationship between HT9, HT8, HT7, HT4 and HT3 regions and brachial vascular and its branches, cephalic vein and its branches, medial antebrachial cutaneous nerve, median nerve and ulnar nerve, which is the morphological basis of the Five-shu acupoints of Shaoyin Heart Meridian for treating some related clinical disorders.

Evaluation of Thermal Changes of the Sole Surface in Horses with Palmar Foot Pain: A Pilot Study.

Horses with palmar foot pain do not show a typical increase in temperature in the palmar aspect of the hoof and heel due to low blood flow. The objectives of the current study were to determine the changes and differences in the thermographic pattern of the sole surface in horses with unilateral palmar foot pain and non-lame horses before and after training. We hypothesized that the thermal pattern and the local temperature of the frog area and toe area would be similar, with an increased local temperature after training in both lame and non-lame horses. A pilot study was conducted to investigate the accuracy of thermography used to detect changes in local temperature and to compare the thermal patterns observed on the sole surface after training. The study group included eight horses with unilateral forelimb palmar foot pain (n = 8) and healthy contralateral limbs (n = 8). Four additional non-lame horses served as controls. The horses were selected for the study based on the following criteria: forelimb with unilateral chronic progressive lameness and positive reactions when performing the hoof test and frog wedge test, degenerative findings of the navicular bone, and improvement in lameness after perineural analgesia of the medial and lateral palmar digital nerve. The local temperatures of the frog and toe areas were measured before and after training in the affected and contralateral limbs in the study group and both forelimbs in the control group using an FLIR E50 thermal camera. Receiver operating characteristic (ROC) curve analysis was applied to check the sensitivity and specificity of the results for the studied groups. The thermal patterns of the hoof presented differences between the three groups of horse limbs. After training, the temperature of the sole surface increased, and its area increased in the limbs affected with palmar foot pain compared with the non-lame limbs in the study group and the limbs in the control group. The temperature of the frog area did not increase after training in the limbs affected with palmar foot pain compared with the same area in the other groups. The ROC curve analysis demonstrated the medical applicability of this tool and showed that thermography is a reliable diagnostic test to correctly discriminate between non-lame horses and those with palmar foot pain. We recommend thermographic scanning of the toe and frog area to detect changes in the local temperature of the sole surface after training to discriminate the horses with palmar foot pain from non-lame ones. Further investigation is required to clarify whether the observed thermographic imaging features of the sole surface are characteristic for horses with palmar foot pain.

Prevalence and clinical significance of increasing head height asymmetry as a measure of forelimb lameness in horses when trotting in a straight line after palmar digital nerve block.

Some horses increase in forelimb lameness, measured as vertical head height asymmetry, or differences in maximums and minimums of head heights (HDmax, HDmin), after a palmar digital nerve (PDN) block. The prevalence of this finding, or what it means clinically, has not been reported in peer-reviewed literature. To estimate the prevalence of increasing head height asymmetry after a PDN block and determine if this is associated with cause of forelimb lameness. Retrospective case series. Head height asymmetry, normalised to expected vertical head displacement, from inertial-sensor data collections of all horses evaluated for forelimb lameness while trotting in a straight line at two different clinics were screened for cases that had an initial PDN block and then another more proximal block in the same limb during the same lameness evaluation. Medical records of the screened cases (n= 213) were evaluated to determine the cause of lameness. Prevalence of increasing head height asymmetry was calculated. Differences in lameness amplitude between groups of cases that remained unchanged (Group 1), that increased (Group 2), and that decreased (Group 3) in head height asymmetry before and after the initial PDN block were compared (Kruskal-Wallis). Determination of the location of the cause of lameness and final diagnoses of cases were compared between Group 1 and Group 2 (chi-squared tests of independence). The PDN block increased head height asymmetry at a prevalence of 32.5% (95% CI=24.5%-41.5%) and 13.8% (95% CI=7.3%-22.9%), in clinic 1 and 2, respectively. Increasing head height asymmetry after an initial PDN block did not predict localization of the cause of forelimb lameness or specific diagnosis (p= 0.1), other than indicating that it is unlikely to be in the foot (p= 0.02). Study samples consisted primarily of Warmbloods (clinic 1) and Quarter Horses (clinic 2). Analysis of blocking induced changes was limited to straight line trot only. Increasing head height asymmetry after PDN block is common during forelimb lameness evaluations. Other than indicating that the cause of lameness is more proximal in the blocked forelimb, this does not help determine the final diagnosis.

A case of led to diagnosis of common palmar digital nerve injury caused by habitual smartphone focal nerve compression by nerve ultrasound in palm

A case of led to diagnosis of common palmar digital nerve injury caused by habitual smartphone focal nerve compression by nerve ultrasound in palm

Repair of complex digital soft-tissue defects using a free composite ulnar artery perforator flap from the volar wrist.

Digital skin defects resulting from trauma are often associated with dysfunction of the digital nerve and the extensor and flexor tendons in the affected fingers. The repair of these complex tissue defects requires a graft containing multiple tissues that can be used to reconstruct the tendons and nerves and restore the skin. Such procedures can cause multiple injuries and significant damage to the donor site. The current study used a novel technique to repair complex dorsal and palmar digital soft-tissue defects. First, multiple tissues were cut and collected from the donor site. Then, part of the flexor carpi ulnaris tendon was transplanted to repair the tendon defect, and a medial antebrachial cutaneous nerve graft was used to repair the digital nerve defect. Finally, a skin flap was used to cover the skin defect. This paper reports on 31 cases of complex soft-tissue digital defects, with defect areas of 2-18 cm2 . One patient presented with a postoperative arterial crisis in the flap. All other patients recovered without experiencing a vascular crisis, flap necrosis, or wound infection. The postoperative flaps were similar in texture to the original digital skin. The sensation and the extension/flexion functions in the affected fingers recovered well. The effect on grip strength, wrist flexion, and forearm sensation was minor and the postoperative total active motion scores of the affected digits were good or excellent in 96.77% of the cases. The flap sensation recovery rate was also excellent in 83.87% of the cases. The present technique facilitates the repair of multiple dorsal and palmar digital soft-tissue, tendon and nerve defects, reduces the damage to the donor site, and significantly improves the success of surgical repair.

Nerve regeneration conduit from inverted human umbilical cord vessel in the treatment of proper palmar digital nerve sections

Treatment of digital nerve injuries, particularly in case of a gap, is challenging. Recovery of finger sensitivity is often incomplete and can impair personal and occupational activity. The need for better nerve regeneration has given rise to alternative treatments such as nerve conduits. This study aimed to evaluate the safety and efficacy of a conduit of freeze-dried inverted human umbilical cord vessel for regeneration in digital nerve section. Twenty-three patients with a mean nerve gap of 6.11 mm (range 2–30 mm and static 2-point discrimination (s2PD) > 15 mm underwent surgical repair of digital nerve section using a nerve regeneration conduit. The primary endpoint was recovery of sensitivity after conduit implantation. Secondary endpoints comprised progression of pain, functional symptoms, pressure threshold, hand-specific symptoms and disabilities, and restored innervation. Mean follow-up was 10.1 ± 4.1 months (range 1–14 months). Sensitivity recovered progressively in the months following implantation. There was a mean decrease of 8.54 mm in s2PD between baseline and last follow-up (p < 0.001). Complete innervation recovered in 83.3% of cases at last follow-up. Pressure threshold and hand-related quality of life improved significantly and symptoms due to nerve sectioning (pain, cold intolerance, hypoesthesia, hyperesthesia) resolved almost completely. There were no safety issues related to the nerve conduit. These results indicate that freeze-dried inverted human umbilical vessels can be a safe and effective option as conduit for digital nerve regeneration.